B.L. SURYANARAYANA CHETTY vs HOSMAT HOSPITAL

COMPLAINANT No. 1 is the husband, complainant No. 2 is the son of the now deceased Nagasundaramma who was suffering from left knee problem and was admitted to OP1 hospital on 12.10.1998 and was operated upon on 21.10.1998. The complainants contend that on account of poor hygienic condition and poor post-operative care Nagasundaramma developed breathing problem and ultimately expired on 10.11.1998. The complainants further contend that the death is as a result of negligence on the part of hospital staff and the doctors who were attending on the patient. On account of her death, the complainants have been subjected to great mental stress and agony. The complainants contend that they have spent more than Rs. 3,34,856 for the treatment. They also contend that OPs 1 to 3 have failed to supply the medical records on the request of the complainants and they have thereby prayed for a total compensation of Rs. 16,25,000 under various heads.

OPS 1 to 3 have filed common version denying the deficiency of service alleged against them. They have contended that Nagasundaramma was aged about 75 years when she visited OP 1 hospital as out-patient on 4.6.1997; she was unable to walk independently for the preceding 6 months. Her medical history revealed that she had undergone left knee replacement on 26.3.1984 in Canada. On her visit to OP1 hospital, she revealed that she had severe pain in both the knees. On examination of the left knee, surgical scar was present along with tenderness. Range of movements was 45, right knee joint also had tenderness with the range of movements 80. It is contended that the patient was advised to undergo total knee replacement on the right side and revisional total knee joint replacement on the left. On 23.6.1997, Dr. Gill who examined the patient opined that as per the Electrocardiogram and Chest X-Ray and other parameters, the patient was fit for operation. It is also contended that Nagasundaramma was hypertensive since 16 years. On 13.7.1997, the patient was admitted for total knee replacement of the right leg which procedure was done on 1.8.1997. Gait training was started from 2.10.1997 with mobilisation exercise (CPM) of the right knee. Patient was discharged on 19.10.1997; she came for follow-up and advice. She was again admitted for total knee replacement of the left knee on 12.10.1998. Revision total knee replacement meant repetition of the surgery for failure of total knee surgery which was already done in Canada in 1984. Before the admission as patient, she was examined by a Cardiologist Dr. Prabhakar on 17.8.1998 who advised that the patient could be taken up for surgery. On admission, the patient was examined by a Consultant Physician Dr. Shankar Kumar who is arrayed as OP7, who opined that the patient was clinically fit for surgery. After surgery on 21.10.1998, swelling of the left lower limb got reduced. Thereafter physiotherapy was given. The OPs contend that before undertaking any procedure or treatment, the patient and hfer family members were explained of the potential risks and complications involved and their consents were taken for such procedure, treatment or operation; proper pre-medications were administered to prevent complications. It was also contended that during the procedure, the patient was given epidural anaesthesia. Specialists like OPs 3 to 9 have supervised the procedure and have also treated the patient. They have contended that the patient woke-up and obeyed of commands after the procedure. The patient was in full control of her mussel and was able to lift her arm and head. The patient was well with her normal mental function during post-operative 24 hours. The OPs contend that the treatment provided to the patient was according to standard technique after going through the entire case history and in consultation with the specialists and, therefore, they deny that there was a deficiency on their part.

They contend that on 8.11.1998 the patient had sudden episode of respiratory distress and seizures. She was restless and she was shifted to ICU. There was evidence of ischemia or infraction. She was treated for Acute Pulmonary Embolism by OP Nos. 5 and 8. On 10.11.1998, Echo was taken which showed original valve motion abnormality which fact was explained to the relatives of the patient. They contend that the patient died due to sudden pulmonary thrombo embolism and cardiac arrest which was unexpected. They further contend that in case of old people, chances of recovery from pulmonary embolism and cardiac arrest was less when compared to younger ones. They further contend that doctors have done their best in accordance with the modern rules of medical treatment.

THE complainants have produced the affidavits sworn to by the 2nd complainant, by one Dr. Srikanth S. Iyengar and by Dr. T.S. Ravindra who have subjected themselves to cross-examination. Exts. Cl to C15 are marked for the complainants. Counter affidavits were filed by OP3, by one Dr. B.V. Venkatesh, Administrator of OP1 hospital and by one Dr. Ajit Benedict Rayan being the Resident Medical Officer of OP1 hospital. OPs have produced the original hospital records in support of their case. We have heard the arguments and perused notes of arguments presented. The points arise for our consideration are that: (1) Whether the complainants have proved deficiency of service on the part of the OPs? (2) What if any is the compen-sation payable and by whom?

POINT Nos. 1 and 2 -In the first instance, the complainants contend that OP1 hospital was not maintained hygienically. Operation Theatre was unhygienic and that has resulted in the complications. On going through the entire evidence on record, we find that apart from the interested testimony of complainant No. 2, there is no independent evidence supporting such contentions and, therefore, the said charge falls to the ground. The next charge is about the course of treatment given to the deceased Nagasundaramma after the operation of the left knee joint on 21.10.1998. According to Ext. Cl, the Discharge Summary issued by the OPs, the patient was well within the normal mental function during the 24 hours after the operation. One unit of blood was transfused on the date of operation and one more on 23.10.1998. Around 7.00 p.m. on 22.10.1998, the patient had become slightly drowsy, but arousable and responded to oral commands. Examination of lungs showed basal crepitation. Renal parameters were raised; patient''s aspirin was stopped; patient was treated for metabolic encephalopathy by Dr. Nalini, a consultant Neurologist. Nephrologist Dr. Talwarkar was called who opined no renal disorder and suspected respiratory acidosis as ABG showed features of mild respiratory acidosis. Dr. Vandana Prabhu, Chest Physician and Dr. Shankar Kumar, Physician treated the patient for respiratory acidosis with continuation oxygen, chest physiotherapy, injection Amikacin and injection Pelox. Patient became normal for a few days and was doing well. Physiotherapy for walking was ordered and was taking diet and was alert and walking. On 8.11.1998, patient had sudden episode of respiratory distress and seizures. Patient was awake on restless and she was shifted to ICU. Respiratory rate was high with expeiratory wheeze seizure appeared to be due to pulmonary embolism and hypoxia; patient was treated for pulmonary embolism including heparinisation by Dr. Nalini Balu, a consultant Neurologist with injection Praxiparine 4100 units subcutaneous and injection Methynpred IV. She went to coma. She was put on ventilator by Dr. Satish, consultant anaesthetist as she was in respiratory failure. Grave prognosis was explained to the patient''s relatives. At 2.30 p.m. on 10.11.1998, patient developed bradycardia and B.P. could not be maintained and then followed by cardiac arrest and asystoloe, cardio pulmonary resuscitation and cardiac massage was given, patient declared dead at 3.20 p.m. The cause of death sudden pulmonary thrombo embolism and cardiac arrest which was sudden and unexpected. The complainants have cross-examined Dr. Srikanth S. Iyengar and Dr. T.S. Ravindra as expert witnesses to prove that there was deficiency on the part of the OPs in treating the deceased Nagasundaramma. Dr. Srikanth S. Iyengar in his affidavit at para 11 has summarised the deficiency in the following words. "In summary, an elderly lady underwent revision of TKR on the left side. She developed severe hypoxic encephalopathy within 24 hours after a major orthopedic procedure along with symptoms of respiratory failure (tachypnea, respiratory acidosis) and alteration of mental status. Metabolic and infectious causes were pursued even in the absence of convincing data. In this clinical setting, especially after a major orthopedic procedure, pulmonary embolism, which is very likely to cause the symptoms and signs seen in Mrs. Nagasundaramma, should have been suspected early on and appropriate treatment with heparin should have been initiated. In spite of findings of hypoxic encephalopathy, respiratory acidosis, congestive cardiac failure and absence of any other plausible explanation for these findings, the important diagnosis of pulmonary embolism was completely neglected. Early diagnosis of pulmonary embolism and appropriate treatment with heparin may have saved the patient''s life and resulted in a more favourable outcome.

IN the cross-examination of OP3 at Para-8, he has admitted that treatment for pulmonary embolism is intensive care oxygen and heparin. The case records do not anywhere show that the patient was administered with heparin for the treatment of pulmonary embolism. Dr. T.S. Ravindra also opined that treatment with heparin would be the treatment for Acute Pulmonary Embolism. This treatment was not given in spite of the fact that it took 2 weeks for the patient to totally collapse after the case was detected as one of pulmonary embolism.

UNDER such circumstances, it cannot be said that the OPs have given treatment to the patient in accordance with the procedure widely accepted in the profession. We, therefore, conclude that the OPs are guilty of negligence. Coming to the question of compensation, we find that the complainants claim to have spent Rs. 3.00 lakh for medical expenses, Rs. 25,000 for miscellaneous expenses during the period of hospitalisation. They have claimed Rs. 5.00 lakh for mental agony, Rs. 5.00 lakh for loss of consortium, Rs. 1.00 lakh for attendant charges and Rs. 2.00 lakhs by way of general damages. Exts. C2 and C3 are the two medical bills produced by the complainants and they show that the complainants have spent about Rs. 2,34,394 as medical expenses. We round of that figure to Rs. 2,50,000 including miscellaneous expenditure. We award another sum of Rs. 1,50,000 by way of compensation for the untimely death of Nagasundaramma including the cost of litigation. Total amount comes to Rs. 4.00 lakh which we award jointly and severally against OPs 1 to 3. In the result, we pass the following Order. ORDER The complaint is allowed in part against OPs 1 to 3 and dismissed against OPs 4 to 9 whose names are already deleted by order dated 8.12.2000 passed by this Commission. OPs 1 to 3 jointly and severally are directed to pay the compensation of Rs. 4.00 lakh (Rupees four lakh only) to the complainants within 30 days from today. On failure to pay the amount within 30 days, the amount shall carry interest @ 9% p. a. from this date till the date of payment. Ordered accordingly.